ICD-10 Coding standards Chapters IV-X Flashcards
What do the fourth character subdivisions at categories E10-E14 represent?
The fourth character subdivisions at categories E10-E14 Diabetes mellitus classify manifestations and complications of diabetes. In order to assign fourth characters .0 - .8 it must be clearly documented in the medical record that the manifestation(s) or
complication(s) is due to diabetes. Any doubt as to whether a condition is linked to the diabetes must be referred back to the responsible consultant for clarification.
How must multiple complications of diabetes be coded?
- Where the patient has multiple complication of diabetes that classify to a dagger and asterisk combination, a dagger and asterisk must be assigned for each complication. This applies whether the fourth character diabetes code is the same or not.
- Where a patient has multiple complications classified to E10-E14 with the fourth character .0,.1,.5 or .6 each complication must be coded following a code from E10-E14, unless the fourth character code from E10-E14 is the same for all complications in which case only one code from E10-E14 is require with the codes for each complications listed afterwards.The exceptions are myocardial infarction, cardiac failure or angina due to diabetes
- The fourth character .7 must only be assigned when it is only stated that the patient has multiple complications of diabetes, and the specific conditions are not identified in the medical record.
How must diabetic gangrene and diabetic ulcer be coded?
Diabetic gangrene or diabetic leg ulcer must be coded to the fourth character subdivision .5
With peripheral circulatory complications and the code(s) to identify the gangrene and/or leg ulcer must be coded in a secondary position.
How must myocardial infarction, cardiac failure or angina due to diabetes be coded?
If a patient is admitted with an acute myocardial infarction, cardiac failure or angina that is a
complication of diabetes, the diabetes must be recorded in a secondary position with a
fourth character of .6 With other specified complications.
How must Hypoglycaemia and hypoglycaemic coma in diabetes be coded?
- When it is documented that a patient has hypoglycaemia in diabetes. A code from E16.- must be assigned followed by a code classifying the diabetes with the fourth character .9 as hypoglycaemia is not considered a complication.
- A code from E16.- must also be assigned following a code from E10-E14 with the fourth character .0 when the patient has diabetes with hypoglycaemic coma.
- Coma and/or hypoglycaemia due to a patient taking insulin correctly must be coded as an adverse effect of insulin.
- Coma and/or hypoglycaemia due to a patient taking too much insulin must be coded as a poisoning.
How is hyperglycaemia in diabetes coded?
Hyperglycaemia in diabetic patients is not considered a complication of diabetes within the ICD classification (with the exception of hyperglycaemic hyperosmolar state), and must be coded with the appropriate code from E10-E14 with the fourth character .9 and addition code to classify hyperglycaemia is not required. (This includes patients with hyperglycaemic coma with fourth character .0)
How must Hyperglycaemic hyperosmolar state in diabetes mellitus be coded?
Patients with HHS with coma: E10-E14 with the fourth character .0 E87.0 Patients with HHS without coma E10-E14 with fourth character .6 E87.0
What must coders not use when assign codes E40-E46 malnutrition?
The notes in the Tabular List at block and category level E40-E46 Malnutrition must not
be used by coders to diagnose malnutrition in a patient. Code assignment must be based
on the diagnosis documented in the medical record, and any uncertainty must be referred
back to the responsible consultant.
What must coders not take into account when assigning E66.-?
Codes in category E66 Obesity must only be coded when a diagnosis of obesity is recorded in the medical record. Where body mass index (BMI) has been recorded in the medical record, this must not be used to assign a code from category E66.- Obesity. A
clinical coder must always refer to the responsible consultant to confirm the clinical significance of a test result, e.g. BMI reading and/or relationship to a specific condition.
DCS.IV.5: Pure hypercholesterolaemia (E78.0)
A diagnosis of ‘high cholesterol’ or ‘Cholesterol’ must only be coded to E78.0 Pure hypercholesterolaemia if confirmed to be a definitive diagnosis of hypercholesterolaemia by the responsible consultant and it is not merely an abnormal test result.
Abnormal cholesterol detected from a blood test without a definitive diagnosis of hypercholesterolaemia must be coded to R79.8 Other specified abnormal findings of blood chemistry instead.
DCS.IV.6: Cystic fibrosis with manifestations (E84)
When cystic fibrosis is documented with a manifestation(s), an additional code or codes
identifying the manifestation(s) must be assigned immediately after a code from category
E84.- Cystic fibrosis, where doing so adds further information about the specific
manifestation(s).
Multiple codes from category E84.- must be used where multiple manifestations are present.
When must dehydration and hypovolaemia always be coded?
Dehydration must always be coded when: • It is documented as severe. • Is treated with IV fluids. • Dehydration in a newborn. Hypovolaemia must always be coded when it is confirmed to have been treated with iV fluids or blood transfusion.
What are Glossary descriptions in chapter V
In addition to inclusion and exclusion terms, chapter V uses glossary descriptions to indicate the content of categories and codes. This is because the terminology of mental disorders varies greatly.
The glossary descriptions must not be used by coders to assign codes. Code selection must be made on the basis of the diagnoses documented by the consultant, even if this conflicts with the definition.
DCS.V.2: Mixed dementia or mixed vascular and Alzheimer dementia (G30.8† and
F00.2*)
Must be coded as:
G30.8† Other Alzheimer disease
F00.2* Dementia in Alzheimer disease, atypical or mixed type (G30.8†)
DCS.V.3: Delirium and acute confusional state
Whenever a documented diagnosis of ‘delirium’, or ‘acute confusional state’, is made in the
patient’s medical record this must be coded using the appropriate ICD-10 code.
Where the cause of the delirium or acute confusional state is known, this must also becoded using the appropriate ICD-10 code. The correct sequencing will depend on the main condition treated or investigated during the consultant episode, in line with DGCS.1:
Primary diagnosis.
A documented diagnosis of ‘delirium’ together with a documented co-morbidity/diagnosis of
‘dementia’ must be coded using the following code:
F05.1 Delirium superimposed on dementia
How must a statement of heavy drinker be coded?
A statement of ‘heavy drinker’ when written in the medical record must only be coded using
a code from F10.-, if:
• the patient has been advised by the responsible consultant to stop drinking because
it will have an adverse effect on their medical condition
or
• the responsible consultant states that the patient is dependent on alcohol.
DCS.V.6: Mephedrone
If the patient is described by the responsible consultant as having ‘acute intoxication’ from
taking Mephedrone, code F15.0 Mental and behavioural disorders due to use of other
stimulants, including caffeine, acute intoxication must be assigned.
How must current smoker be coded?
When it is documented in the medical record that a patient smokes, code F17.1 Mental
and behavioural disorders due to use of tobacco, harmful use must be assigned. If further information is given such as dependence, then the fourth character code may change.
Code Z72.0 Tobacco use must not be assigned for a current smoker.
